Accommodation for Mental Health Issues

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

The Centers for Disease Control and Prevention released a study last week which looked at teen mental health since the fall of 2021. The study has received widespread public attention because the findings are shocking although maybe not to the parents of teenagers. It shows a disturbing trend for adolescent girls.

According to the CDC’s new survey, girls’ mental health is declining across the U.S. compared to boys. Six in ten girls felt persistently sad or lonely, nearly double the rate of teen boys. Nearly one in three teen girls gave serious thought to attempting suicide. Teens today are growing up under an umbrella of anxiety that would have been unfathomable during their parents’ adolescence. Mental health issues are escalating, and this is our future nursing workforce.

With this report as a backdrop, I see growing concern among nurse leaders about the mental health of new graduates as they enter practice environments. Baseline stress, anxiety, and clinical depression have skyrocketed among new graduates. Many nurse leaders now tell me they feel like therapists as they help new staff cope with meltdowns and panic attacks. There has also been a huge increase in nurses asking for workplace accommodation secondary to mental health issues. Consider the following stories that managers have shared with me since the beginning of 2023:

I have hired several new graduates with a clear understanding that the position involved night rotation. Even before the schedule is posted with night rotation, I now receive letters from Psychiatrists telling me that the new graduate is being treated for anxiety and stress. The risks would be too high to put them on nights and disrupt their sleep.

A clinical instructor told me the other day that the student could not accompany a patient to radiology. She is on an academic accommodation plan which restricts her from being assigned to working in small places because of claustrophobia. Besides, the instructor said she would not work in a hospital when she graduates.

A new graduate has a panic attack on the unit. I send her home, and she calls in for the next four shifts. She has no PTO and has told me her mental health is her top priority before her job.

A nurse under treatment for PTSD secondary to her COVID experience files an accommodation request to be selected for heavily coveted new remote positions just posted in our medical center. She needs to work at home with her support dog.

A faculty member recently said I would be amazed at the number of nursing students on academic accommodation plans for mental health issues today. In the past, many of these students would have either not been admitted or counseled out of pursuing a career as stressful as nursing, but not today. Programs worry about lawsuits and enrollment. Students graduate with the expectation of future accommodation as they move into clinical practice.

Work accommodation is covered under the Americans with Disabilities Act passed in 1990. The goal was to prevent discrimination against those with disabilities. As with any policy, much of what happens now results from employment case law. Major depression and anxiety disorders (including agoraphobia, post-traumatic stress disorder, and obsessive-compulsive disorder) usually qualify as disabilities under ADA because of their effect on daily life.  Employers are generally required to provide a reasonable accommodation unless doing so would create an undue hardship. Accommodation needs to be requested, and most experts advise that it should be done in writing. According to the ADA, employers must provide a “flexible, interactive process” with the employee to come to agreeable terms. Employers cannot ask about mental health issues during the interview process.

We are in uncharted territory with mental health accommodation, especially if a growing percentage of the nursing workforce requests it. Nursing is inherently stressful, and even the healthiest work environments can’t always offer enough psychological safety to avoid stress, anxiety, and depression. Frontline nurse leaders struggle to be supportive yet provide excellent patient care. As we look at our future generation of nurses, this is a leadership conversation that we need to begin having now.